Glaucoma and amaurosis associated with long-term application of topical corticosteroids to the eyelids

The development of glaucoma and amaurosis in a 29-year-old woman with atopic dermatitis is described. The association of the eye involvement with many years of daily application of fluorinated corticosteroid ointment to the eyelids is suggested.     

Symptomatic dermographism: wealing, mast cells and histamine are decreased in the skin following long-term application of a potent topical corticosteroid

Clobetasol propionate 0.05% ointment and an otherwise identical steroid-free base were applied topically to a 10 cm2 area on the anterior thighs of six patients with symptomatic dermographism for 6 weeks. Four patients showed a significantly decreased wealing response to stroking of steroid pretreated skin compared to that of control sites. There was a parallel decrease in mast cell numbers and histamine levels in skin biopsies taken from the steroid treated areas. At 6 weeks two patients demonstrated a decrease in flare areas following the intradermal injection of compound 48/80 in steroid pretreated skin compared to base treated sites. Flare areas following intradermal injection of histamine in these two patients were equivalent in base and steroid treated skin.     

Ocular complications after cosmetic periocular diode laser application to the eyelids

A 25-year-old woman underwent diode laser application on the both upper eyelids in the dermatology department of a private hospital to obtain a cosmetic healing of the reddish look on her eyelids without any protective lenses. The patient experienced severe uveitis, atonic pupils, raised intraocular pressure, and increased sensitivity to light in her eyes on the following day of the procedure. Topical steroids and pressure-lowering agents were able to treat the acute uveitis and glaucoma, unfortunately the patient suffered from irreversible atonic and atrophic pupils and photosensitivity. It is recommended that cosmetic laser application on the periocular area should be avoided, and if it is still to be performed, it should be applied cautiously and the patient should be informed of the potential ocular complications.     

A comparison of techniques to assess skin blanching following the topical application of glucocorticoids

Summary Glucocorticoid-induced dermal blanching provides a useful research tool to study steroid potency and sensitivity. Conventional measurement of the intensity of blanching relies on subjective assessment by a trained observer using a visual score. Several objective techniques have recently been reported to detect skin blanching, but their sensitivity has not been compared previously with subjective visual recordings. In this report we aimed to establish whether objective methods offer sufficient sensitivity to be employed in epidemiological studies of glucocorticoid responsiveness. ealthy subject we applied beclomcthasone dipropionate at three concentrations (1. 10 and 100 μg/ml) under an occluded dressing overnight. The following morning we measured blanching using a visual score, laser Doppler velocimetry with the MBF 3D monitor (Moor Instruments Ltd. U.K.) and a perfusion imager (Lisca. Sweden), and reflectance spectrophotometry with the Dia-Stron ‘erythemameter’. Using the visual score, blanching was detected at all concentrations of steroid. Neither laser Doppler instrument detected vasoconstriction at any concentration. By contrast, the rellectance spectrophotometer successfully recorded blanching at 10 and 100 μg/ml. but not at 1 μg/ml. We conclude that laser Doppler instruments, including the novel scanning perfusion imager. do not detect glucocorticoidinducced skin blanching perhaps because it reflects venular rather than arteriolar vasoconstriction. By contrast, the Dia-Stron reflectance spectrophotometer has sufficient sensitivity to be used as an alternative to visual assessment in epidemiological studies of human glucocorticoid-induced dermal blanching.     

Milia restricted to the eyelids

We report a highly unusual clinical case of multiple, bilateral milia restricted to the upper eyelids, with a family history suggestive of autosomal dominant inheritance.     

Septic emboli to the skin following angioplasty

Invasive vascular procedures have good efficacy and safety profiles and are now widely used for the diagnosis and treatment of many cardiovascular disorders. However, they do have potential complications that can occasionally be life-threatening. We present a new case of infectious pseudoaneurysm following percutaneous transluminal coronary angioplasty and complicated by septic emboli to the skin. It is a rare condition characterized by persistent bacteremia, sepsis of unknown origin, and regional septic emboli. Histopathology of the skin lesions typically reveals gram-positive coccobacilli and septic vasculitis. The condition carries a significant morbidity and mortality, making early diagnosis essential. Both cholesterol and septic emboli should be considered in the differential diagnosis of skin lesions after invasive vascular procedures.     

Breast cancer metastatic to the eyelids

Metastases to the eyelids are rare. They may appear as diffuse swellings, nodules or ulcerations. Most often they correspond to the dissemination of a breast adenocarcinoma. An 83 year old woman is reported with mammary adenocarcinoma metastasizing to the eyelids.     

眼袋脂肪填充上睑凹陷的临床应用

目的观察应用自体眼袋脂肪游离移植填充上睑凹陷的临床效果。方法眼袋祛除术中取出的脂肪团,将其填充于切眉术并发的上睑凹陷。结果12例患者眼睑凹陷采用眼袋脂肪填充后,随访3～6个月,眼睑凹陷得到明显改善,效果均满意。结论眼袋脂肪填充上睑凹陷,具有手术操作简单,并发症少等优点。     

Lipid uptake and skin occlusion following topical application of oils on adult and infant skin

BACKGROUND: Topical application of oils and oil-based formulations is common practice in skin care for both adults and infants. Only limited knowledge however is available regarding skin penetration and occlusive potential of oils and common methods for measuring skin moisturization fall short when it comes to the moisturizing effect of oils. OBJECTIVE: In this study we used in vivo confocal Raman microspectroscopy to test the efficacy of paraffin oil (mineral oil) and two vegetable oils in terms of skin penetration and occlusion. Petrolatum was used as a positive control. METHODS: The products were applied topically on the forearms of nine volunteers and seven infants and Raman spectra were acquired before and at 30 and 90 min following application. Depth concentration profiles for lipid and water were calculated from the Raman spectra. Skin occlusion was assessed from the amount of stratum corneum (SC) swelling measured from the water concentration profiles. RESULTS: The paraffin oil and the vegetable oils penetrate the top layers of the SC with similar concentration profiles, a result that was confirmed both for adult and infant skin. The three oils tested demonstrated modest SC swelling (10-20%) compared to moderate swelling (40-60%) for petrolatum. CONCLUSION: These data indicate that there is no statistical difference between the paraffin oil and vegetable oils in terms of skin penetration and skin occlusion. The results for petrolatum show that in vivo confocal Raman microspectroscopy is sensitive and specific enough to measure both lipid uptake and skin occlusion events following topical application.     

Postural skin colour changes during the corticosteroid blanching assay.

OBJECTIVE: To assess the effect of the position of a limb (dependency) on the cutaneous vasoconstrictor (blanching) assay (VCA) using topical corticosteroid preparations. METHOD: Two studies were performed on the forearms of healthy volunteers using tristimulus reflectance colorimetric assessments. The first one conducted in 60 normal adults aimed at quantifying the range of variation in the skin chromaticity a* when the arm was successively positioned horizontally and vertically, either in the upward or downward direction. In the second study, 16 volunteers were selected according to a weak spontaneous postural dependency of the limb in a* (<2 units). The blanching effect of 0.1% mometasone furoate, 0.1% betamethasone valerate and petrolatum were compared to the colour of an untreated site. Chromaticity a* and the colorimetric variable (DeltatL*(2) + Deltata*(2))(0.5) were measured in time following a 2-hour application. RESULTS: The postural variations in skin colour varied among subjects. The majority of them (80%) presented a difference in a* higher than 2 units between the upright and downward arm positions. The upright position appeared to be the most sensitive to show significant differences in the VCA. Mometasone furoate exhibited the most prominent effect, significantly higher than betamethasone valerate and controls. CONCLUSION: The corticosteroid VCA is influenced by the position of the limb. The upright position increases the sensitivity of the test. Mometasone furoate is more potent than betamethasone valerate.